Publication: Predictibilidad y validez de la planificación quirúrgica en cirugía ortognática mediante dolphin imaging system® y su relación con la calidad de vida según los cuestionarios OHIP-14 y OQLQ
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2017-02-06
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Universidad Complutense de Madrid
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Abstract
Las deformidades dentofaciales constituyen un problema de salud pública con una demanda creciente, en la que el resultado estético tiene un gran impacto en el ámbito psicosocial del individuo. El éxito quirúrgico va a ser apreciado por el paciente si su oclusión y su perfil facial estético son correctos y, por ello, es fundamental poder prever el resultado quirúrgico mediante herramientas informáticas de planificación dentofacial. El cirujano va a valorar el éxito del tratamiento por la satisfacción del paciente y porque el resultado final se ajuste a la predicción realizada previamente. Por esta razón es muy importante que el programa que se utilice ofrezca un resultado fiable que se ajuste de la mejor manera posible al futuro resultado postoperatorio. Entre los programas disponibles en el mercado, uno de los más utilizados es Dolphin Imaging y es necesario realizar estudios que validen la precisión del mismo y confirmen los algoritmos de relación de movimiento de los tejidos blandos en virtud del movimiento óseo. Este programa dispone además de una herramienta de ajuste labial para mejorar la predicción de estas estructuras, fuente de la mayoría de errores en planificación digital en cirugía ortognática, que carece de estudios que valoren su predictibilidad con respecto a la planificación sin dicha aplicación. El éxito del tratamiento de los pacientes intervenidos de una deformidad dentofacial es percibida como una mejora de su calidad de vida, pudiendo no coincidir con el éxito del tratamiento para el cirujano, para el que el éxito puede ser un resultado postoperatorio acorde a la planificación digital prequirúrgica. Varios cuestionarios valoran la calidad de vida de diferentes patologías, siendo los más específicos en procedimientos en la cavidad oral y en cirugía ortognática el Oral Health Impact Profile Questionnaire (OHIP-14) y el Orthognathic Quality of Life Questionnaire (OQLQ). Material y métodos: se realizó la comparación de los registros prequirúrgicos con Dolphin Imaging System® y los registros finales de una muestra de 27 pacientes sometidos a cirugía ortognática. Mediante la superposición de las imágenes, se comparó la diferencia de las medidas horizontales, verticales y angulares de varios puntos cefalométricos óseos y blandos, tanto en el global de la muestra como estratificando según diagnóstico y tratamiento aplicado. Asimismo, se compararon las proporciones de movimiento de los tejidos duros y blandos de la muestra con los que utiliza el programa, para validar si son correctos. Por otra parte, se solicitó a todos los pacientes al final del tratamiento que valorasen su calidad de vida con los cuestionarios OHIP-14 y OQLQ para investigar la posible relación de los resultados con el grado de error de la planificación con Dolphin Imaging y determinar si el éxito del tratamiento para el paciente se ajusta al éxito por parte del cirujano o si el detrimento en la calidad de vida está provocado por otras causas como complicaciones, clínica articular o parestesias labiales...
Dentofacial deformities are a growing public health problem in which the esthetic result has a major impact on people’s psicosocial sphere. The surgical success is appreciated by the patient in terms of a normal oclusion and esthetical facial profile and, due to that reason, is essential to be able to precisely forecast the surgical result with computerized dentofacial planning tools. The surgeon is going to estimate the treatment success by the satisfaction of the patient and the accuracy of the final result according to the previous planning. Because of that it is very important for the program used for the planning to offer a reliable result and to be as much accurate as possible. Among the commercial programs, one of the most widely used is Dolphin Imaging and it is necessary to develop studies that may validate its precision and confirm the algorithms used in soft tissue movements according to bone movements. This program also contains a lip adjustment tool to improve the planning of these structures, which are the main source of errors in orthognathic surgery digital planning. This issue lacks of studies that compare results of planning with or without this tool. The treatment success of the patients who undergo a surgery due to a dentofacial deformity is appreaciated as an improvement in their quality of life, and this may not be in accordance with the surgeon treatment success, who might value the success in terms of accuracy of presurgical digital planning. Several questionnaires estimate the quality of life in different pathologies, but the most important ones in oral cavity procedures and orthognathic surgery are the Oral Health Impact Profile Questionnaire (OHIP-14) and the Orthognathic Quality of Life Questionnaire (OQLQ). Material and methods: a comparison of presurgical records with Dolphin Imaging System® and final records of 27 patients who underwent orthognathic surgery was developed. The differences in horizontal, vertical and angular measures of several bone and soft tissue cephalometric points was made comparing those records by superimposition, considering the whole sample and classified by diagnosis or treatment. Rates of movement of soft and hard tissues were also compared with the ones used by the program, to check whether they are correct or not. On the other hand, patients were required to fill both OHIP-14 and OQLQ questionnaires at the end of the treatment to estimate their quality of life and investigate the possible relationship between the scores and the degree of error of the Dolphin Imaging planning so that it could be determined whether the patient considered treatment success was close to the surgeon considered success or whether the lack of quality of life could be caused by complications, joint symptoms or lip paresthesias...
Dentofacial deformities are a growing public health problem in which the esthetic result has a major impact on people’s psicosocial sphere. The surgical success is appreciated by the patient in terms of a normal oclusion and esthetical facial profile and, due to that reason, is essential to be able to precisely forecast the surgical result with computerized dentofacial planning tools. The surgeon is going to estimate the treatment success by the satisfaction of the patient and the accuracy of the final result according to the previous planning. Because of that it is very important for the program used for the planning to offer a reliable result and to be as much accurate as possible. Among the commercial programs, one of the most widely used is Dolphin Imaging and it is necessary to develop studies that may validate its precision and confirm the algorithms used in soft tissue movements according to bone movements. This program also contains a lip adjustment tool to improve the planning of these structures, which are the main source of errors in orthognathic surgery digital planning. This issue lacks of studies that compare results of planning with or without this tool. The treatment success of the patients who undergo a surgery due to a dentofacial deformity is appreaciated as an improvement in their quality of life, and this may not be in accordance with the surgeon treatment success, who might value the success in terms of accuracy of presurgical digital planning. Several questionnaires estimate the quality of life in different pathologies, but the most important ones in oral cavity procedures and orthognathic surgery are the Oral Health Impact Profile Questionnaire (OHIP-14) and the Orthognathic Quality of Life Questionnaire (OQLQ). Material and methods: a comparison of presurgical records with Dolphin Imaging System® and final records of 27 patients who underwent orthognathic surgery was developed. The differences in horizontal, vertical and angular measures of several bone and soft tissue cephalometric points was made comparing those records by superimposition, considering the whole sample and classified by diagnosis or treatment. Rates of movement of soft and hard tissues were also compared with the ones used by the program, to check whether they are correct or not. On the other hand, patients were required to fill both OHIP-14 and OQLQ questionnaires at the end of the treatment to estimate their quality of life and investigate the possible relationship between the scores and the degree of error of the Dolphin Imaging planning so that it could be determined whether the patient considered treatment success was close to the surgeon considered success or whether the lack of quality of life could be caused by complications, joint symptoms or lip paresthesias...
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Tesis inédita de la Universidad Complutense de Madrid, Facultad de Medicina, Departamento de Cirugía, leída el 15/01/2016